An intervention service is an effort to promote behaviors that optimize mental and physical health of the patient or discourage or reframe behaviors of the patient considered potentially health-averse. Wellness screenings are one form of intervention service. In one example, wellness screening may be conducted by a pharmacist, another pharmacy employee, or other healthcare provider. In a wellness screening, certain vital statistics of a patient may be collected. In one example, those vital statistics may include blood pressure, total cholesterol measurement, high-density lipoproteins cholesterol measurement, low-density lipoproteins cholesterol measurement, triglycerides measurement, blood glucose measurement, patient height, patient weight, and patient waist measurement. Other statistics or information may also be collected from the patient in a wellness screening.
Other forms of intervention service include, but are not limited to, medication therapy management (MTM) services, immunization messaging, cash prescription monitoring, refill adherence, high-risk medication monitoring, and diabetic screenings or monitoring. High-risk medications are a listing of medications published by the Centers for Medicare and Medicaid Services (CMS) and identified as posing a higher risk to patients, especially to seniors. When one or more of the listed high-risk medications are prescribed to a patient or a predetermined number of refills for the particular high-risk medication has been reached or exceeded as part of the current healthcare claim transaction, it may be beneficial to notify the pharmacy to alert the pharmacy to the fact and to request verification that the one or additional high-risk medication should be requested for the patient identified in the healthcare claim transaction.
MTM services include five core components: a medication therapy review, personal medication record, medication-related action plan, intervention and/or referral, and documentation and follow-up. MTM services include medical care provided by pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients. MTM services include a broad range of professional activities including, but not limited to, performing patient assessment and/or a comprehensive medication review, formulating a medication treatment plan, monitoring efficacy and safety of medication therapy, enhancing medication adherence through patient empowerment and education, documenting and communicating MTM services to prescribers in order to maintain comprehensive patient care.
A medication therapy review is a systematic process of collecting patient and medication-related information which occurs during the pharmacist-patient encounter. In addition, the medication therapy review assists in the identification and prioritization of medication-related problems. During the medication therapy management encounter, the pharmacist develops a personal medication record for use by the patient. The personal medication record includes all prescription and non-prescription products/medications and may need to be updated periodically. After assessing and identifying medication-related problems, the pharmacist develops a patient-specific medication-related action plan. The medication-related action plan is a list of self-management actions necessary to achieve the patient's specific health goals. In addition, the patient and pharmacist utilize the medication-related action plan to record actions and track progress towards health goals. During the medication therapy management session, the pharmacist identifies medication-related problems and determines appropriate interventions for resolution. Following the patient encounter and/or intervention, the pharmacist must document his/her encounter and determine appropriate patient follow-up. The other intervention services can have similar documentation requirements for the pharmacist.
One problem related to the pharmacies providing intervention services to patients and the collection of data (e.g., screening parameter data) from the patient at the pharmacy is knowing what information may need to be collected for a particular intervention service in order to satisfy a particular claims processor's requirements and for the pharmacy to receive payment for conducting the intervention service. Another problem can be getting the collected data to the claims processor who is sponsoring (e.g., paying for) these intervention services. While pharmacies, via their pharmacy practice management systems (e.g., the pharmacy computer) are accustomed to submitting prescription claim transactions for payment of prescription medications, products, and/or services by claims processors, those same pharmacy practice management systems are not capable of collecting and sending all the data that must be collected during an intervention service in a single transaction.
Further, another problem related to intervention services involves situations when the intervention service is not completed (in whole or in part) or certain screening parameter data that is to be obtained from a patient during an intervention service is not obtained. Currently, there is no method of requesting or obtaining from the pharmacy, such as via the pharmacy practice management system information as to why the intervention service was not completed or certain screening parameter data was not obtained. This situation leaves the claims processor or sponsor without the information from the intervention service and without any understanding of why the information could not be obtained.